First Contact Practitioners’ (FCPs) and General Practitioners’ Perceptions Towards FCPs Delivering Vocational Advice to Patients with Musculoskeletal Conditions: A Qualitative Investigation of the Implementation Potential of the I-SWAP Initiative

Abstract

Purpose Musculoskeletal (MSK) pain is a common cause of work absence. The recent SWAP (Study of Work And Pain) randomised controlled trial (RCT) found that a brief vocational advice service for primary care patients with MSK pain led to fewer days’ work absence and provided good return-on-investment. The I-SWAP (Implementation of the Study of Work And Pain) initiative aimed to deliver an implementation test-bed of the SWAP vocational advice intervention with First Contact Practitioners (FCP). This entailed adapting the SWAP vocational advice training to fit the FCP role. This qualitative investigation explored the implementation potential of FCPs delivering vocational advice for patients with MSK pain. Methods Semi-structured interviews and focus groups were conducted with 10 FCPs and 5 GPs. Data were analysed thematically and findings explored using Normalisation Process Theory (NPT). Results I-SWAP achieved a degree of ‘coherence’ (i.e. made sense), with both FCPs and GPs feeling FCPs were well-placed to discuss work issues with these patients. However, for many of the FCPs, addressing or modifying psychosocial and occupational barriers to return-to-work was not considered feasible within FCP consultations, and improving physical function was prioritised. Concerns were also raised that employers would not act on FCPs’ recommendations regarding return-to-work. Conclusion FCPs appear well-placed to discuss work issues with MSK patients, and signpost/refer to other services; however, because they often only see patients once they are less suited to deliver other aspects of vocational advice. Future research is needed to explore how best to provide vocational advice in primary care settings.

Constructing therapeutic support and negotiating competing agendas: A discourse analysis of vocational advice provided to individuals who are absent from work due to ill-health

“… O’Brien et al (2008) reported that patients often sought advice from their GP about work-related issues, but they perceived GPs did not have sufficient time or knowledge to address these issues adequately. We observed similar concerns in a recent study exploring the potential for First Contact Practitioners (FCPs) to deliver vocational advice to patients absent from work with musculoskeletal pain ( Saunders et al, 2022 ). The FCPs cited lack of time to explore the barriers and obstacles to patients returning-to-work in depth, and lack of confidence in addressing some of the psychosocial issues underlying work absence.…”

Supporting translation of research evidence into practice—the use of Normalisation Process Theory to assess and inform implementation within randomised controlled trials: a systematic review

“…Patel et al [ 102 ] Australia Mixed-methods process evaluation Primary care CVD management Prospective 31. Saunders et al [ 103 ] UK Qualitative Primary care Musculoskeletal pain Retrospective 32. Schnabel et al [ 104 ] UK Qualitative Stroke services Augmented arm rehabilitation, supported self-management after stroke Prospective 33.…”

“…Regarding the operationalisation of the sub-constructs, while just over half of the studies ( n = 22) [ 36 , 68 – 72 , 75 , 78 , 85 – 87 , 95 , 99 – 101 , 103 , 104 , 108 – 111 , 113 , 114 ] did not specify the use of any sub-constructs, nearly 30% of studies ( n = 12) [ 73 , 74 , 76 , 77 , 80 – 84 , 89 – 91 , 93 , 97 , 102 , 105 , 112 ] explicate their use of all 16 and use among the remaining studies (19%, n = 8) [ 79 , 88 , 92 , 94 , 96 , 98 , 106 , 107 ] varied. Figure 2 further illustrates the frequency of sub-construct use.…”

“…Synthesis revealed consistency among studies in the overall operationalisation of NPT. Across all included studies, NPT is most commonly first operationalised during the data collection stage (52%, n = 22) [ 36 , 69 – 71 , 73 , 74 , 76 – 78 , 87 , 88 , 92 , 93 , 96 , 97 , 104 , 105 , 107 , 109 , 110 , 112 – 114 ], followed by data analysis (36%, n = 15) [ 68 , 72 , 75 , 79 , 80 , 85 , 86 , 94 , 95 , 98 , 100 , 103 , 106 , 108 , 111 ] and finally, from the outset of the design (12%, n = 5) [ 81 – 84 , 89 – 91 , 99 , 102 ]. However, this should be interpreted with caution as it refers to the stage NPT is first deployed for each study and does not include subsequent utilisation.…”

General practitioners’ stay-at-work practices in patients with musculoskeletal disorders: using Intervention Mapping to develop a training program

“…We have identified various perspectives on the roles and responsibilities as well as barriers at systemic and organisational levels that cannot be addressed through GP training courses alone [ 35 ]. Ultimately, this leads to questions about who will be best suited to help the patients stay-at-work [ 36 ], and how they are best incentivised [ 35 ]. In the end, it matters more that patients receive the best possible help in maintaining a life with high social participation including participation in work life than who is involved in the management.…”